Packet: Tiffin Regular City Council Meeting (05/19/2026)

STATEMENT OF BIDDER’S Project Name: Roberts Ferry Road & Village QUALIFICATIONS (CONT.) Drive Traffic Signal Improvements 3. Certification I hereby certify that: (1) all the information submitted in this Statement of Bidder’s Qualifications Form, including all attachments, is true to the best of my knowledge and belief; (2) I am authorized to sign this Statement of Bidder’s Qualifications Form on behalf of the Contractor whose name appears in Item 1 above; and (3) if any of the information I have provided herein becomes inaccurate, prior to execution of any Contract for the Project, I will immediately provide the Owner with updated accurate information in writing. Dated this day of , 20 . Name of Contractor: By: Title: State of ) ) SS County) On this day of , 20 , before me, the undersigned, a Notary Public in and for the State of , personally appeared and , to me known to be the identical person(s) named in and who executed the foregoing instrument, and acknowledged that (he) (she) (they) executed the instrument as (his) (her) (their) voluntary act and deed. Notary Public in and for the State of My commission expires , 20 Statement of Bidder’s Qualifications SBQ-4 Roberts Ferry Road & Village Drive Traffic Signal Improvements